Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Clinical features that should prompt suspicion of idiopathic intracranial hypertension (IIH) include:
- New onset headache, often daily and diffuse, which may worsen on lying down or with Valsalva maneuvers such as coughing or straining NICE CG150 Rehder 2020.
- Visual disturbances, particularly transient visual obscurations (brief episodes of vision loss or blurring), diplopia, or visual field defects due to papilledema NICE CG150 Bénard-Séguin É 2025.
- Tinnitus, especially pulsatile tinnitus synchronous with the heartbeat, is a common symptom NICE CG150 Antonio 2025.
- Signs of raised intracranial pressure such as nausea, vomiting, and neck stiffness may be present but are less specific NICE CG150 Rehder 2020.
- On examination, papilledema is a key clinical sign and should raise suspicion of IIH in the appropriate clinical context NICE CG150 Bénard-Séguin É 2025.
- Other neurological deficits are typically absent, and the patient is usually alert and oriented NICE CG150 Antonio 2025.
In summary, the combination of new persistent headache, visual symptoms (especially transient visual obscurations), pulsatile tinnitus, and papilledema on examination should prompt consideration of IIH and urgent neuro-ophthalmological assessment NICE CG150 Rehder 2020Bénard-Séguin É 2025Antonio 2025.
Key References
- CG150 - Headaches in over 12s: diagnosis and management
- NG232 - Head injury: assessment and early management
- CKS - Migraine
- CKS - Headache - medication overuse
- CKS - Headache - tension-type
- (Rehder, 2020): Idiopathic Intracranial Hypertension: Review of Clinical Syndrome, Imaging Findings, and Treatment.
- (Bénard-Séguin É and Costello, 2025): Idiopathic Intracranial Hypertension with Papilledema.
- (Antonio, 2025): Clinical Features and Diagnosis of Idiopathic Intracranial Hypertension.